Q: How did the idea of conducting a QI study on pathology collection come about? Why is this so important to study?
Lisa Sinsel: The study was initiated in 2008 because we were receiving random calls from our pathology group, Caris Diagnostics, to request additional information or clarification regarding a pathology specimen. This is what prompted our investigation.
Preventing the likelihood of a variance is important not only in our centers but to all healthcare providers collecting pathology specimens. Lack of communication between healthcare providers during specimen collection is dangerous and has the potential to be extremely detrimental to a patient’s health.
Q: What steps did you take to collect data on pathology variance?
LS: We first started by defining what classified a “pathology variance.” The endoscopy centers identified pathology variances as illegible requisitions, missing demographics, incorrect demographics, missing data on the pathology requisition and incorrect specimen labeling. After defining what constituted pathology variances, we were able to identify which areas were most problematic and also utilize the data to evaluate for trends. For example, we could assess if there were any trends by staff member, procedure type, specimen location and so on. That allowed us to focus our plan of correction accordingly.
From there, we provided education to the staff on our findings from the data we collected and then reviewed the most appropriate method to collect pathology. We also continued collaborating with Caris, who monitors and tracks any pathology variance and generates a quarterly report for us.
Q: What new tools did you implement in order to reduce pathology variance?
LS: Our initial investigation revealed a higher occurrence of variances related to pathology requisitions. This process involved staff members, primarily the nursing staff, physically documenting and completing a carbon copy requisition. The top copy of the requisition was sent with the specimens, and the carbon copy remained in the facility. Further review of the requisition revealed that the print on the requisition was small, making it difficult to write clearly or legibly. In an effort to eliminate physically documenting on a requisition and decreasing the likelihood of variances related to documentation, facility management agreed to install Caris’ “Path Connect” software in all the procedure rooms. This program eliminated physical documentation and replaced it with an electronic version. Requisitions became electronic quality, legible, and standardized. Implementation of the “Path Connect” system decreased the number of variances related to requisitions to zero incidents during 2009.
Q: Are there any new procedures or policies that were set in place?
LS: We also implemented a process of doing a “time out” during all specimen collections. The nurse and technician ensure that the correct label is placed on all specimens at the time of collection and read the contents of the label out loud to ensure that the procedure room team is all in agreement. This allows everyone to verify the patient’s name, specimen location and bottle number. Ever since these changes took place, our pathology variance became essentially nonexistent.
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